Prepregnancy vascular dysfunction in women who subsequently develop hypertension during pregnancy

Objective: To evaluate vascular dysfunction using both physiologic measures and biochemical markers, longitudinally, prior to and during pregnancy, in nulliparous women who had uncomplicated pregnancies compared to those who developed complicated hypertension during pregnancy. Methods: Twenty healthy nulliparous women were studied during the follicular phase and in early (EP) and late (LP) pregnancy. All had singleton conceptions and delivered at term, seventeen with uncomplicated pregnancies (NP) and three who developed complicated hypertension (HP) after the LP evaluation. We compared prepregnancy, EP and LP pulse wave velocity (PWV) and soluble vascular cell adhesion molecule (sVCAM-1) between the NP and HP groups. PWV was measured using ultrasound and simultaneous echocardiogram tracing then calculated as the estimated distance divided by the interval between EKG R-wave peak and peak brachial artery flow. SVCAM-1 was measured using a commercially available kit. Data are mean +/- SE, significance accepted as p < 0.05. Results: The NP group had significantly lower prepregnant PWV (NP: 2.66 +/- 0.06 m/s, HP: 3.00 +/- 0.04, p = 0.02), but PWV was not different at the EP or LP time points. SVCAM-1 was significantly lower prior to pregnancy and during EP and LP in the NP group (Prepregnancy: NP: 712 +/- 32 ng/mL, HP: 1058 +/- 107, p < 0.001; EP: NP: 695 +/- 31 ng/mL, HP: 924 +/- 52, p = 0.004; LP: NP: 663 +/- 25 ng/mL, HP: 946 +/- 36, p < 0.001). Conclusions: PWV and sVCAM-1 may be important prepregnancy discriminators useful in assessing the risk for preeclampsia prior to pregnancy. (C) 2013 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.